Tirabrutinib is an oral BTK inhibitor, mainly used for the treatment of B-cell malignancies such as Waldenström macroglobulinemia. Its administration method, management of missed doses, and dose adjustment directly affect efficacy and safety, as briefly described below.

I. Fasting or with meals?

Administration with meals or after meals is recommended. Food intake can increase the exposure of tirabrutinib, helping to ensure stable efficacy.

Take the medication at a fixed time every day to maintain a consistent dosing rhythm and avoid large fluctuations in blood drug concentration.

Swallow the whole tablet with an adequate amount of water; do not split, crush, or chew it.

Avoid taking it together with strong CYP3A inhibitor foods such as grapefruit and pomelo, to prevent increased blood drug concentration and elevated toxicity risk.

II. How to handle missed doses?

If a missed dose is noticed and there is still a long time before the next dose, take the missed dose as soon as possible.

If the next dose time is already approaching, skip the missed dose and take the next dose according to the original schedule.

Never take a double dose at one time to make up for a missed dose.

After taking the make-up dose, continue medication according to the original schedule and do not disrupt subsequent dosing intervals.

III. Principles of dose adjustment

Hepatic impairment: In patients with moderate to severe hepatic impairment, drug exposure is increased, and the starting dose usually needs to be reduced or use should be avoided; adjustment must be made according to the physician's instructions.

Concomitant medication: When used together with strong CYP3A inhibitors (such as ketoconazole and clarithromycin) or inducers (such as rifampin), the dose should be adjusted or concomitant use should be avoided.

Adverse reactions: When grade ≥3 toxicity occurs (such as cytopenia, infection, bleeding, arrhythmia), medication should be suspended, and after recovery, it may be reduced or restarted according to the physician's instructions.

Bleeding and surgery: During the perioperative period, medication usually needs to be suspended for several days; the specific interval should be discussed with a physician.

Any dose adjustment should be made under the guidance of a physician; do not increase, decrease, or stop the medication on your own.